Healthcare Provider Details

I. General information

NPI: 1306564877
Provider Name (Legal Business Name): CYPRESS PT ORANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 N 16TH ST
ORANGE TX
77632-4630
US

IV. Provider business mailing address

2034 W MAIN ST
LUTCHER LA
70071-5364
US

V. Phone/Fax

Practice location:
  • Phone: 409-330-4005
  • Fax: 409-330-4159
Mailing address:
  • Phone: 504-487-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY P BOE JR.
Title or Position: MANAGING PARTNER
Credential:
Phone: 504-487-2336